In a recent issue of the Hastings Center Report, Paul and Marilyn Bridge discuss the difficulties and frustrations they encountered with the physicians and hospital concerning a proposal to withhold treatment from their severely defective newborn son, Christopher. Born some three months prematurely, he had signs of viral encephalitis. His long-term outlook was quite dim: he had severe mental retardation, and would possibly suffer from uncontrollable convulsions, deafness, blindness, and quadraplegia. Brain damage was extensive, and was thought to extend to the cortex. While Christopher was not terminally ill nor in any immediate danger of dying, the pediatrician suggested that there would be situations in the future which perhaps ought not be treated, such as infection or the aspiration of food. The family rejected that option, and insisted on treatment until Christopher, on his 75th day of life, suffered cardiac arrest. After three days of ventilator support, the parents agreed to discontinue the heroic means supporting their son whom they now believed to be terminally ill and approaching brain death.

The Hill-Burton Program was enacted in 1946 to provide federal assigtance to communities for the purpose of constructing and modernizing health care facilities. As a condition of Hill-Burton funding, the contracting hospital is required to assume obligations of “uncompensated care” and “community service.” Indigents eligible for Hill-Burton free care can, after exhausting administrative remedies, obtain injunctive relief to enforce compliance with the Program's regulations. However, it is unsettled today whether a hospital's noncompliance with these obligations to provide free care can be raised as an affirmative defense in a hospital collection action. Until recently, courts throughout the country have held that a patient could not raise the affirmative defense of Hill-Burton noncompliance. Yet, the 1979 Hill-Burton Regulations, as well as the recent decision in Hospital Center at Orange v. Cook, are indicators of the start of a contrary trend to allow the defense. This article examines the 1979 Regulations and court decisions on the affirmative defense and argues against allowing the defense.

In an effort to broaden its scope in the area of medicolegal education, the Executive Committee of the American Society of Law & Medicine voted in Cktober 1981 to establish a Health Law Teachers Section for its members who teach health law related courses in any school of law, medicine, public health, health administration, or nursing.

Angela R. Holder, J.D., LL.M., Treasurer of the Society and Counsel for Medicolegal Affairs and Associate Professor at Yale University School of Medicine, recommended that the Society expand its efforts to assist multidisciplinary individuals who share a common interest—education. While the Society was a co-sponsor of a 1980 Health Law Teachers Workshop, chaired by George J. Annas, J.D., M.P.H., of Boston University School of Medicine, the Society had not given formal, organized attention to the specialized needs of health law teachers.

Nurses frequently wonder about the legal aspects of using siderails to prevent patient falls from bed. Questions arise as to when siderails are clinically indicated; whether a patient may refuse the use of siderails; whether, when a patient does fall from bed, the fall resulted from negligent failure to use siderails; and whether a decision to use siderails is a medical or nursing judgment. This article examines the legal issues involved in the use of siderails and provides some recommendations for the use of siderails and other restraints.

Liability for a patient's fall from bed is imposed according to the general principles of the law of negligence—when the patient-plaintiff can demonstrate that a particular act or omission on the part of the defendant (usually the hospital, through its nursing staff) did not conform to the accepted standard of care, and that this deviation resulted in harm to the patient.

In a lawsuit involving nursing negligence in the course of an operative procedure, generally the question arises as to whether liability for the nurse's negligence will rest on the nurse's employer or on the operating physician.

Imposition of vicarious liability for a plaintiff's injury is based upon a master-servant relationship between the negligent actor and a third party, such as a hospital or surgeon. Under the doctrine of respondeat superior, liability is imposed upon an employer for the negligent acts of employees, which arise in the course and scope of employment. The operating physician, however, may also be declared liable through the application of two legal mechanisms: the doctrines of captain of the ship and borrowed servant.

Under the captain of the ship doctrine, responsibility is imposed upon the physician because he is the one who is looked to by the patient as responsible for the patient's welfare and safety generally.

Corporate liability has proven to be fertile ground for claimants against hospitals. Charitable hospitals’ loss of immunity has produced a sudden and often traumatic change in hospital liability. The impact of corporate liability has been slower, but has produced the same result—extended hospital liability.

In the October 1980 issue of Medicolegal News, Lee J. Dunn, Jr., discussed the then-current tendency of courts to find hospitals culpable in tort litigation under the theory of corporate liability. That article concentrated on two decisions: Johnson v. Misericordia Community Hospital, and Bost u. Riley. Six months later, an article by Miles J. Zaremski discussed the continuing trend to hold hospitals accountable for the selection and maintenance of physicians on their medical staffs, and examined the Johnson decision, Fridena v. Evans, and Capan v. Divine Providence Hospital.

At one point in Edgar Allan Poe’s Narrative of Arthur Gordon Pym of Nantucket, Pym, who has stowed away in the hold of a whaling vessel, believes he has been abandoned and that the hold will be his tomb. He expressed sensations of “extreme horror and dismay,” and “the most gloomy imagining, in which the dreadful deaths of thirst, famine, suffocation, and premature interment, crowded in as the prominent disasters to be encountered.”

It is probably uncommon for hospitalized patients to feel as gloomy as Pym. Nevertheless, installed in a strange institution, separated from friends and family, forced to wear a degrading costume, confined to bed, and attended to by a variety of strangers who may or may not keep the patient informed of what they are doing, the average patient is intimidated and disoriented. Such an environment encourages dependence and discourages the assertion of individual rights.

As the physician-director of Boston’s Beth Israel Hospital has warned: “today’s hospital stands increasingly to become a jungle, whose pathways to the uninitiated are poorly marked and fraught with danger. . . .”